What should be included in a written prescription for a PureWick (external catheter) system?

PureWick Written Prescription Requirements

A written prescription for the PureWick external catheter system must include the patient's diagnosis (typically urinary incontinence), the specific device name ("PureWick Female External Catheter System"), quantity needed (typically 30-60 wicks per month based on 8-12 hour replacement intervals), and the medical necessity statement indicating this is to avoid indwelling catheterization and its associated infection risks. 1

Essential Prescription Components

Patient Information and Diagnosis

• Document the primary indication: urinary incontinence in a female patient who would otherwise require indwelling catheterization 1
• Specify that the patient does NOT have urinary retention requiring bladder decompression, as this is a contraindication 1
• Note absence of severe perineal wounds or active perineal infections if applicable 1

Device Specifications

• Product name: "PureWick Female External Catheter System" or "BD PureWick System" 2, 3
• Components required: External catheter wicks, suction canister, and low-pressure suction pump 2, 3
• Quantity: Based on replacement every 8-12 hours, prescribe 60-90 wicks per month (2-3 per day) 1

Medical Necessity Statement

• State that this device eliminates the 5-10% daily bacteriuria risk associated with indwelling catheters 1
• Note that the PureWick avoids the 1.11 per 1000 catheter-days CAUTI rate of indwelling devices 1
• Emphasize that external collection methods are preferred by urological guidelines to avoid infection risks 1

Duration and Replacement Schedule

Device Change Frequency

• Prescribe replacement every 8-12 hours as standard protocol 1
• Include instructions for immediate replacement when visibly soiled, saturated, malpositioned, or contaminated with fecal matter 1
• Note that patients with heavy urinary output or significant diaphoresis require more frequent changes 1

Skin Care Requirements

• Include orders for perineal inspection at each device change for moisture damage, pressure injury, or infection 1
• Prescribe gentle perineal cleansing with mild soap and water at each change 1
• Order barrier cream or moisture barrier ointment for prophylactic use or early skin breakdown 1

Infection Prevention Orders

Technique Requirements

• Specify clean technique (not sterile) for device changes and perineal care 1
• Order clean gloves for all device changes 1
• Critical distinction: Unlike indwelling catheters, the PureWick does NOT require antimicrobial prophylaxis at insertion or during use 1

What NOT to Include

• Do not order prophylactic antibiotics, as these are not indicated for external catheter use 1
• Do not prescribe internal insertion of the device—this is a critical safety error 1

Common Prescription Pitfalls to Avoid

Inappropriate Use Scenarios

• Never prescribe for urinary retention: The PureWick cannot decompress the bladder and is contraindicated for retention 1
• Do not use as first-line in patients with active perineal infections without addressing the underlying infection first 1
• Avoid prescribing for patients who cannot tolerate the device due to anatomical variations or extreme agitation 1

Laboratory Considerations

• Note in the prescription that urine collected via PureWick is acceptable for most urinalysis and chemistry tests 4
• However, warn against relying solely on PureWick-collected urine for critical microscopic analysis, as there may be statistically significant decreases in white blood cell and crystal counts 1, 4

Documentation Requirements

• Include clear instructions that saturated devices must never be left in place 1
• Specify that regular skin assessment is mandatory and cannot be neglected 1

Sample Prescription Language

A complete prescription should read: "PureWick Female External Catheter System for management of urinary incontinence. Dispense 60-90 external catheter wicks per month. Replace device every 8-12 hours or when soiled/saturated. Perform perineal cleansing and skin inspection with each change. Apply barrier cream as needed. This device is medically necessary to avoid indwelling catheterization and associated CAUTI risk of 1.11 per 1000 catheter-days." 1